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Recognize that foot structure and function is incredibly complex and can easily go awry.

Normal foot architecture is maintained through a balance of forces applied by muscles and tendons on bones.

Atrophy of a muscle group through nerve damage can lead to deformity.

Watch areas that can be open to friction and repetitive micro-trauma which can lead to callus and ulceration.

Types of foot deformities include bunion, hammer and claw toe and Charcot foot.

The bunion, or hallux valgus, causes increased pressures and friction and repetitive micro-trauma that out paces the healing capacity at the bunion site.

Hammer and claw toe deformities develop from atrophy of the small muscles between the toes. Both the dorsal and plantar aspects of the involved toes are at risk for friction and pressure related trauma with subsequent ulceration.

Charcot foot is one of the most severe diabetic foot deformity in which the entire mid-section of the foot collapses and forms a classic “rocker bottom” sole.

Caused by a combination of sensory and autonomic nerve dysfunction

Microscopic fractures to the tarsal bones trigger an inflammatory response

Results in subsequent dissolution of the mid-bones

The arch becomes inverted, which causes high plantar pressures

These patients are at extreme risk for ulceration

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